Decision-making experiences of health professionals in withdrawing treatment for children and young people: A qualitative study.

OBJECTIVE: To explore factors that influence professionals in deciding whether to withdraw treatment from a child and how decision making is managed amongst professionals as an individual and as a team. STUDY DESIGN: Semi-structured interviews were conducted with a purposive sample of health professionals working at a UK Children's Hospital, with children with life-limiting illnesses whose treatment has been withdrawn. Data were transcribed verbatim, anonymized and analysed using a thematic framework method. RESULTS: A total of 15 participants were interviewed. Five interrelated themes with associated subthemes were generated to help understand the experiences of health professionals in decision making on withdrawing a child's treatment: (1) understanding the child's best interests, (2) multidisciplinary approach, (3) external factors, (4) psychological well-being and (5) recommendations to support shared decision making. CONCLUSION: A shared decision-making approach should be adopted to support professionals, children and their families to make decisions collectively.

Mental Toughness and Associated Personality Characteristics of Marathon des Sables Athletes.

Mental toughness (MT) is commonly referred to as an important prerequisite for sustained athletic achievement. The increased research focus on MT has led to the development of a consistent debate centered around whether the construct is a unidimensional or multidimensional trait, and whether it can be differentiated from similar constructs such as hardiness. In order to move toward more clarity of MT, the present study is exploratory in nature, using athletes who have competed in the Marathon des Sables (MdS) ultra-endurance event. The MdS is a timed 250 km race in the Sahara Desert that takes place over 6 days in temperatures exceeding 40°C. Forty two British MdS competitors were recruited via the United Kingdom organizing company. Each participant completed the NEO PI-R as a measure of the five major domains of personality, as well as the six traits or facets that define each domain. Additionally, they completed the Sport Mental Toughness Questionnaire (SMTQ). The MdS sample's NEO PI-R results were compared against general population norms, and results showed a distinct ultra-endurance athlete profile characterized by significantly higher levels of extraversion and openness to experience. Additionally, the MdS sample's SMTQ scores were higher than the normed sample consisting of a collection of athletes representing multiple sports. Finally, linear regression analyses indicated a convergence between the two measures, supporting the argument that MT may in fact be measured by a general personality questionnaire such as the NEO PI-R.

Systematic Review: Psychosocial Interventions for Children and Young People With Visible Differences Resulting From Appearance Altering Conditions, Injury, or Treatment Effects.

OBJECTIVE: Evaluate critically the evidence of the effectiveness of psychosocial interventions for children/young people (<18 years old) with visible differences in improving self-esteem, social experiences, psychological well-being, and behavioral outcomes. METHODS: Studies were systematically identified using electronic databases, appraised according to eligibility criteria and evaluated for risk of bias. Findings were reported using the PRISMA checklist. RESULTS: Studies were identified that evaluated residential social camps, exercise with counseling, social skills training (SIST), behavioral therapy (BT), and cognitive behavioral therapy (CBT). Risk of bias within studies was high. Camp studies and exercise with counseling showed little or no effect postintervention on self-esteem, social experiences, and psychological well-being. The five studies evaluating SIST, CBT, and BT provided limited support for their effectiveness. CONCLUSIONS: Evidence base is inconclusive. Further rigorous research using appropriate outcome measures to evaluate the effectiveness of interventions for young people with visible differences is required.

Motivational interviewing-based interventions and diabetes mellitus.

This review assesses whether motivational interviewing (MI)-based interventions are effective at improving health behaviours in adults with diabetes. Electronic databases were searched for articles that investigated the use of MI and diabetes self-management between 1966 and March 2010. In total, 464 titles were found; after duplicates were removed, 112 studies remained. Of these, 24 abstracts were identified as potentially relevant. No studies were excluded on the basis of their methodology. By use of a data extraction sheet, eight studies were identified as relevant once full articles were examined. Positive results in health-behaviour improvement were reported in four studies. These were: reduced smoking, improved blood glucose, improved diet and weight management. Studies varied in quality; four were methodologically weak owing to small sample sizes, lack of clarity of scoring measurement tools and/or limited use of valid measurements, and reported inclusion/exclusion criteria. In conclusion, MI cannot be recommended as an evidenced-based approach to diabetes self-management.

The acute effects of physical activity on cigarette cravings: systematic review and meta-analysis with individual participant data.

AIMS: To conduct an updated systematic review and the first meta-analysis of experimental trials investigating the acute effects of short bouts of physical activity (PA) on strength of desire (SoD) and desire to smoke (DtS) using individual participant data (IPD). METHODS: A systematic review of literature and IPD meta-analyses included trials assessing the acute effects of shorts bouts of PA on SoD and DtS among temporarily abstaining smokers not using pharmaceutical aids for smoking cessation. Authors of eligible studies were contacted and raw IPD were obtained. Two-stage and one-stage IPD random-effects meta-analyses were conducted. Participants engaging in PA were compared against control participants, using post-intervention SoD and DtS with baseline adjustments. RESULTS: A two-stage IPD meta-analysis assessing effects of PA on SoD yielded an average standardized mean difference (SMD) between PA and control conditions (across 15 primary studies) of -1.91 [95% confidence interval (CI): -2.59 to -1.22]. A two-stage IPD meta-analysis assessing effects of PA on DtS yielded an average SMD between PA and control conditions (across 17 primary studies) of -2.03 (95% CI: -2.60 to -1.46). Additional meta-analyses, including those using a one-stage model, those including only parallel arm studies and meta-analyses comparing only moderate exercise against a control condition, showed significant craving reduction following PA. Despite a high degree of between-study heterogeneity, effects sizes of all primary studies were in the same direction, with PA showing a greater reduction in cravings compared with controls. CONCLUSIONS: There is strong evidence that physical activity acutely reduces cigarette craving.

Exercise for the management of cancer-related fatigue in adults.

BACKGROUND: Cancer-related fatigue is recognised as an important symptom associated with cancer and its treatment. A number of studies have investigated the effects of physical activity in reducing cancer-related fatigue. This is an updated version of the original Cochrane review published in The Cochrane Library (2008, Issue 1). The original review identified some benefits of physical activity on fatigue in cancer both during and after adjuvant treatment. We identified a number of limitations in the evidence, providing clear justification for an updated review. OBJECTIVES: To evaluate the effect of exercise on cancer-related fatigue both during and after cancer treatment. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 1, 2011), MEDLINE (1966 to March 2011), EMBASE (1980 to March 2011), CINAHL (1982 to March 2011), British Nursing Index (January 1984 to March 2011), AMED (1985 to March 2011), SIGLE (1980 to March 2011) and Dissertation Abstracts International (1861 to March 2011) using key words. We also searched reference lists off all studies identified for inclusion and relevant reviews. In addition, we handsearched relevant journals and contacted experts in the field of cancer-related fatigue. SELECTION CRITERIA: We sought and included randomised controlled trials (RCTs) that investigated the effect of exercise on cancer-related fatigue in adults. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed the risk of bias of studies and extracted data based upon predefined criteria. Where data were available we performed meta-analyses for fatigue using a random-effects model. MAIN RESULTS: For this update we identified a total of 56 studies (4068 participants) for inclusion (28 from the original search and 28 from the updated search), with the majority carried out in participants with breast cancer (28 studies). A meta-analysis of all fatigue data, incorporating 38 comparisons, provided data for 1461 participants who received an exercise intervention and 1187 control participants. At the end of the intervention period exercise was seen to be statistically more effective than the control intervention (standardised mean difference (SMD) -0.27, 95% confidence interval (CI) -0.37 to -0.17). Benefits of exercise on fatigue were observed for interventions delivered during or post-adjuvant cancer therapy. In relation to diagnosis, we identified benefits of exercise on fatigue for breast and prostate cancer but not for those with haematological malignancies. Finally, aerobic exercise significantly reduced fatigue but resistance training and alternative forms of exercise failed to reach significance. AUTHORS' CONCLUSIONS: The findings of the updated review have enabled a more precise conclusion to be made in that aerobic exercise can be regarded as beneficial for individuals with cancer-related fatigue during and post-cancer therapy, specifically those with solid tumours. Further research is required to determine the optimal type, intensity and timing of an exercise intervention.